Persistent Challenge in US Health Equity Revealed by New NASEM Report

A recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) has put persistent inequities in the US health care system into perspective. According to a statement from NAESM, despite the country’s position as a global leader in health care expenditure, the US has made minimal progress in advancing health care equity over the past 2 decades.¹ Racial and ethnic disparities remain glaring defects in the nation's health care system, leading to some of the poorest health outcomes among high-income countries.

Despite the country’s position as a global leader in health care expenditure, the report revealed that the US has made minimal progress in advancing health care equity over the past 2 decades | Image Credit: MargJohnsonVA - stock.adobe.com

“Eliminating health care inequities is an achievable and feasible goal, and improving the health of individuals in the nation’s most disadvantaged communities improves the quality of care for everyone,” Georges C. Benjamin, MD, co-chair of the report committee, executive director of the American Public Health Association, said in the statement. “This is not a zero-sum game—we are all in this together.”

The report "Ending Unequal Treatment: Strategies to Achieve Equitable Health Care and Optimal Health for All," is extensive, with a few key points regarding the persistent and pervasive health care inequities.²

Persistent Racial and Ethnic Disparities

Awareness and action to address inequities have been initiated in the country, and yet, significant disparities in health outcomes persist across different racial and ethnic groups. Minoritized populations, particularly Black, Hispanic, American Indian, and Alaska Native communities, continue to experience higher rates of chronic conditions, such as diabetes, and poorer outcomes in areas like maternal and infant health compared with their White counterparts. The report acknowledged that these disparities are rooted in longstanding structural inequities within the health care system and are exacerbated by social determinants of health (SDOH), such as socioeconomic status and access to quality care.

Diabetes is a poignant example of these inequities. The report cites that American Indian and Alaska Native adults exhibit the highest prevalence of diabetes at 13.6%, followed by Black populations at 12.1%, Hispanic populations at 11.7%, Asian populations at 9.1%, and White populations at 6.9%. Despite these high prevalence rates, non-White patients often receive less access to newer, costlier medications and advanced diabetic technologies. Black patients with diabetes, for instance, have hospitalization rates more than 2.5 times higher than their White counterparts.

Structural Barriers in Health Care Access

The inequities are not confined to chronic diseases. A significant portion of the report delves into the structural inequities that pervade the health care system. Differences in services among public and private health insurance payers result in unequal access to care.

Report findings show that racially and ethnically minoritized individuals are significantly less likely to have a usual source of primary care. During emergency department visits, they endure longer wait times and receive less acute triage severity scores. Long-term care facilities that predominantly serve minoritized residents offer fewer clinical services, have lower staffing levels, and receive more care deficiency citations.

Incremental Progress and Ongoing Challenges

Over the past 20 years, there has been progress in raising awareness about health care inequities, conducting research, and implementing policies aimed at addressing these issues. However, there is no consistent evidence that equity gaps have been narrowing year after year for racially and ethnically minoritized groups.

The Affordable Care Act (ACA) played a significant role in expanding health care coverage and improving access to services across these groups. However, the report notes that structural limitations and legal challenges have impeded the full realization of many of the ACA's provisions.

Need for Comprehensive Policy Actions

To address these deep-rooted inequities, the report advocates for a range of actions at the federal, state, and local levels. Key recommendations include improving data collection on health disparities, increasing funding for programs that enhance access and quality of care for underserved populations, and enforcing existing laws designed to promote equity. The report also calls for substantial investments in research to better understand and develop interventions for health inequities and urges the alignment of Medicaid reimbursement rates with those of Medicare to ensure more equitable access to care.

Goals for Transformative Change

The report identifies 5 strategic goals with corresponding actions designed to foster comprehensive and systematic intervention at every level of health and health care:

1. Generate Accurate and Timely Data on Inequities: Federal agencies should enhance the collection and use of data related to race, ethnicity, tribal affiliation, and language to better identify and address health inequities.
2. Equip Health Care Systems and Expand Effective Interventions: Congress should increase funding for programs that have proven to advance access, quality, and equity in health care.
3. Invest in Research and Evidence Generation: The National Institutes of Health and other funders should expand their support for research focused on health care inequities, structural racism, and health-related social needs.
4. Enforce Existing Laws and Build Accountability Systems: Adequate resources must be allocated to enforce laws and regulations aimed at eliminating health care inequities.
5. Eliminate Inequities in Coverage, Access, and Quality: Congress should establish pathways to ensure affordable, comprehensive health insurance for everyone and align Medicaid payment policies with those of Medicare.

“Many of the tools needed to reach these goals are already available and need to be fully used,” Jennifer DeVoe, MD, co-chair of the committee and professor at Oregon Health & Science University, said in a statement. “With concerted national effort and adequate resources, the health care system can be transformed to deliver high-quality, equitable care to all.”²

References

1. Little progress has been made in closing racial and ethnic gaps in U.S. health care; Federal government should act to fix structural inequities. News release. NAESM. June 26, 2024. Accessed June 27, 2024. https://www.nationalacademies.org/news/2024/06/little-progress-has-been-made-in-closing-racial-and-ethnic-gaps-in-u-s-health-care-federal-government-should-act-to-fix-structural-inequities

2. Benjamin GC, DeVoe JE, Amankwah FK, Nass SJ. Ending unequal treatment: Strategies to achieve equitable health care and optimal health for all. Front Matter. NAESM. The National Academies Press. doi:10.17226/27820